Diabetes and foot disease

Introduction

Diabetes is a disease where the body cannot produce insulin or cannot use it effectively. Insulin is the hormone that is responsible for helping the cells take in sugar to use for energy. When this does not happen properly, the levels of sugar in the blood can become too high. Prolonged periods of high sugar levels in the blood can wreak havoc on many areas of the body, including the feet.

Diabetes is a chronic condition that can cause a number of serious complications. Problems with the feet are one of the most common. Foot ulceration in diabetes mellitus is common. Foot problems remain the commonest cause of hospital admission amongst patients with diabetes in Western countries. The lifetime risk of a patient with diabetes developing an ulcer is 25%, and up to 85% of all lower limb amputations in diabetes are preceded by foot ulcers. As many as 50% of older patients with type 2 diabetes have risk factors for foot problems and regular screening by careful clinical examination is essential; those found to be at risk should attend more regular follow-up together with education in foot self-care.

The key to management of diabetic neuropathic foot ulceration is aggressive debridement with removal of callus and dead tissue, followed by application of some form of the cast to offload the ulcer area. Most ulcers will heal if pressure is removed from the ulcer site if the arterial circulation is sufficient and if the infection is managed and treated aggressively. Any patient with a warm swollen foot without ulceration should be presumed to have acute Charcot neuroarthropathy (CN) until proven otherwise. The optimal approach to reducing ulceration requires regular screening, patient education and a team approach to management, both in the community and in hospital.

What are Diabetic foot problems?

People with diabetes are prone to foot problems caused by prolonged periods of high blood sugar. There are two main foot problems, each of which can have serious complications. Both type 1 and type 2 diabetes cause damage to blood vessels and peripheral nerves that can result in problems in the legs and feet. Two main conditions, 1) peripheral artery disease (PAD), and 2) peripheral neuropathy are responsible for the increased risk of foot problems in people with diabetes.

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Diabetes also can lower the amount of blood flow in your feet. Not having enough blood flowing to your legs and feet can make it hard for a sore or an infection to heal. Sometimes, a bad infection never heals. The infection might lead to gangrene.

Gangrene and foot ulcers that do not get better with treatment can lead to an amputation of your toe, foot, or part of your leg. A surgeon may perform an amputation to prevent a bad infection from spreading to the rest of your body, and to save your life. Good foot care is very important to prevent serious infections and gangrene.

What can you do to keep your feet healthy?

Some diabetes foot-related problems can be prevented by taking careful steps to observe and care for your feet. Keeping blood sugar levels under control (in the ranges advised by your doctor), and following your recommended diet and exercise program are the best way to prevent all complications of diabetes, including foot problems.

In addition to keeping your diabetes under control, you can take steps to care for your feet, including the following:-

  • Wash your feet every day

foot disease

  • Smooth corns and calluses gently
  • Trim your toenails straight across
  • Wear shoes and socks at all times
  • Protect your feet from hot and cold
  • Keep the blood flowing to your feet
  • Get a foot check at every health care visit

Causes of Diabetic Foot Problems

Several risk factors increase a person with diabetes chances of developing foot problems and diabetic infections in the legs and feet.

 

  • Footwear –

 

Poorly fitting shoes are a common cause of diabetic foot problems.

 

  • Nerve damage –

 

People with long-standing or poorly controlled diabetes are at risk for having damage to the nerves in their feet. The medical term for this is peripheral neuropathy.

  • Poor circulation –

Especially when poorly controlled, diabetes can lead to accelerated hardening of the arteries or atherosclerosis. When blood flow to injured tissues is poor, healing does not occur properly.

  • Trauma to the foot –

Any trauma to the foot can increase the risk for a more serious problem to develop.

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foot disease

 

  • Infections

  • Smoking –

 

Smoking any form of tobacco causes damage to the small blood vessels in the feet and legs. This damage can disrupt the healing process and is a major risk factor for infections and amputations. The importance of smoking cessation cannot be overemphasized.

Conclusion

Diabetic foot problems also include bunions, corns, calluses, hammertoes, fungal infections, dryness of the skin, and ingrown toenails. These problems are not specific to diabetes, but may occur more commonly due to the nerve and vascular damage caused by diabetes. Treatment depends on the exact type of foot problem. Surgery or even amputation may be required for some cases. A number of different kinds of foot problems can occur in people with diabetes. Symptoms and signs of diabetic foot problems arise due to the decreased sensation from nerve damage as well as the lack of oxygen delivery to the feet caused by vascular disease.

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